Provider Demographics
NPI:1124122122
Name:DUERFELDT, DOROTHY L (PA-C)
Entity type:Individual
Prefix:MS
First Name:DOROTHY
Middle Name:L
Last Name:DUERFELDT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 410
Mailing Address - Street 2:
Mailing Address - City:VALENTINE
Mailing Address - State:NE
Mailing Address - Zip Code:69201-0410
Mailing Address - Country:US
Mailing Address - Phone:402-376-2525
Mailing Address - Fax:402-376-1627
Practice Address - Street 1:512 NORTH GREEN ST
Practice Address - Street 2:
Practice Address - City:VALENTINE
Practice Address - State:NE
Practice Address - Zip Code:69201-1982
Practice Address - Country:US
Practice Address - Phone:402-376-3770
Practice Address - Fax:402-376-3779
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1172363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6827680Medicaid
NE38637OtherBCBS OF NEBRASKA
NE38637OtherBCBS OF NEBRASKA
NE278615Medicare PIN